Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0182543
Title: Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality
Authors: Sim Y.E.
Wee H.E.
Ang A.L. 
Ranjakunalan N.
Ong B.C. 
Abdullah H.R. 
Keywords: adult
age
aged
American Society of Anesthesiologists Physical Status score
anemia
anesthesia
Article
blood transfusion
cohort analysis
comorbidity
controlled study
demography
discocyte
disease classification
erythrocyte parameters
female
follow up
health hazard
heart surgery
high risk patient
human
major clinical study
male
mean corpuscular volume
megalocytosis
middle aged
mortality
normocytosis
perioperative mortality
preoperative anemia
preoperative complication
prevalence
rating scale
red cell distribution width
retrospective study
scoring system
sex difference
Singapore
surgical patient
surgical risk
surgical technique
adolescent
anemia
blood
erythrocyte disorder
preoperative care
prevalence
prognosis
survival rate
young adult
hemoglobin
Adolescent
Adult
Aged
Anemia
Erythrocyte Indices
Erythrocytes, Abnormal
Female
Hemoglobins
Humans
Male
Middle Aged
Preoperative Care
Prevalence
Prognosis
Retrospective Studies
Singapore
Survival Rate
Young Adult
Issue Date: 2017
Publisher: Public Library of Science
Citation: Sim Y.E., Wee H.E., Ang A.L., Ranjakunalan N., Ong B.C., Abdullah H.R. (2017). Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality. PLoS ONE 12 (8) : e0182543. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0182543
Abstract: Introduction: Preoperative anemia and high red cell distribution width (RDW) are associated with higher perioperative mortality. Conditions with high RDW levels can be categorized by mean corpuscular volume (MCV). The relationship between RDW, anemia and MCV may explain causality between high RDW levels and outcomes. We aim to establish the prevalence of preoperative anemia and distribution of RDW and MCV among pre-surgical patients in Singapore. In addition, we aim to investigate the association between preoperative anemia, RDW and MCV levels with one-year mortality after surgery. Methods: Retrospective review of 97,443 patients aged > = 18 years who underwent cardiac and noncardiac surgeries under anesthesia between January 2012 and October 2016. Patient demographics, comorbidities, priority of surgery, surgical risk classification, perioperative transfusion, preoperative hemoglobin, RDW, MCV were collected. WHO anemia classification was used. High RDW was defined as >15.7%. Multivariate regression analyses were done to identify independent risk factors for mild or moderate/severe anemia and high RDW (>15.7). Multivariate cox regression analysis was done to determine the effect of preoperative anemia, abnormal RDW and MCV values on 1-year mortality. Results: Our cohort comprised of 94.7% non-cardiac and 5.3% cardiac surgeries. 88.7% of patients achieved 1 year follow-up. Anemia prevalence was 27.8%—mild anemia 15.3%, moderate anemia 12.0% and severe anemia 0.5%. One-year mortality was 3.5%. Anemia increased with age in males, while in females, anemia was more prevalent between 18–49 years and > = 70 years. Most anemics were normocytic. Normocytosis and macrocytosis increased with age, while microcytosis decreased with age. Older age, male gender, higher ASA-PS score, anemia (mild- aHR 1.98; moderate/severe aHR 2.86), macrocytosis (aHR 1.47), high RDW (aHR 2.34), moderate-high risk surgery and emergency surgery were associated with higher hazard ratios of one-year mortality. Discussion: Preoperative anemia is common. Anemia, macrocytosis and high RDW increases one year mortality. © 2017 Sim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/165782
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0182543
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